Q&A/Mary T. Alfinito; Early Treatment Can Aid a Troubled Child

By DONNA GREENE

Published: March 1, 1998

THE book ''Reviving Ophelia,'' on best-seller lists for more than three years, details the potential trauma of being a teen-age girl. News accounts tell of putting depressed children on Prozac and of an increasingly common practice of diagnosing children with attention disorders and putting them on drugs. It is enough to make you think that being a child can be a nightmare.

Indeed it can be, says Mary T. Alfinito, child and adolescent coordinator of the Outpatient Mental Health Services Division of St. Vincent's Hospital-Westchester. But she emphasizes that almost every troubled child can be helped if the right treatment is offered early enough.

Situated in Harrison, St. Vincent's serves adults and children with mental health and/or drug- and alcohol-abuse problems. Ms. Alfinito, a clinical social worker with special counseling certification and a resident of Putnam, has worked there for almost nine years. Before that, she worked at various mental health jobs, primarily with troubled adults. Here are excerpts from a recent conversation with her:

Q. Are children more troubled today than, say, a decade ago?

A. I think so. I think they have a lot more stresses, less support; the systems are getting more complicated. By that I mean more complicated in terms of troubled families and their accessing resources. There are budget cuts. I think the world is just more complicated. There is more technology and more things to adapt to.

Q. Some people of the older generation who grew up during the Depression think those were much harder times than today. What is your opinion?

A. They had the family structure, and I think the size of the communities were smaller then. You certainly didn't have as much crowdedness and the stresses of technology. I think cities have gotten very big. I come from a family where my parents were children during the Depression. But the Bronx years ago was farmland when they grew up. It's not like that now when I go back home. It's a very different place.

Q. Are the stresses internal or external?

A. I think they're both. I think the family system doesn't have as many supports as it used to. There are a lot of nuclear families and a lot of single-parent families, so unlike three generations ago where you may have had lots of aunts, uncles, grandparents around you, you don't have that anymore. In terms of the internal stresses, I think you have a lot more technology to adjust to. The amount of things you have to learn are more. I think school districts are having trouble with that. And, of course, there are more drugs. That is another piece.

Q. Every child probably gets depressed occasionally. What are the signs that a parent should watch for that will help them know when to seek professional help?

A. When they're starting to see severe changes in behavior beyond what is the norm for that kid. A lot of times kids with depression become very irritable, and some kids can become aggressive. They have changes in their eating habits. They have changes in their school functions, so they also show depression differently than adults, which is another key. They're more likely to become very irritable, oppositional. They'll have changes in sleeping habits, appetite changes and poor school functions versus, in the case of adults -- while there are some who do,-- most don't lie in bed all day and just shut down.

Q. Consider the book ''Reviving Ophelia,'' which painted a scary picture of life as a teen-age girl. Is that what it is like for adolescent girls, or is that just anecdotal?

A. Well, in terms of eating disorders described in the book, we've seen a fair amount of eating-disorder kids here. We've even seen a few males, which is unusual, but they do exist. I think that kids have a little bit more pressure in terms of the culture about their diet and their looks and things like that. But not every kid is going to develop an eating disorder or an obsessive-compulsive disorder that may increase the likelihood of an eating disorder. But we see more cases of it than we used to.

Q. More than 10 years ago? Is this on the increase?

A. It's hard to tell at times. When you look at the statistics, some of it says, yes it's on the increase. But I also think it's being diagnosed more often now. So probably years ago these kids didn't get treatment early on. And you got them when they were adults. I think you have a better chance when you get them earlier.

Q. We want our children to perform well because that is the way they will get jobs and survive. On the other hand, you are saying the stress can cause problems. How does a parent find balance?

A. I think open communication is very important: find out what kids are feeling, find out what kids are struggling with and thinking about. Really talk about what's out there. They know they're going to get exposed to drugs. They know that eating habits are important. Learn more about nutrition and their health. Parents are really role models, and if they can open up the lines of communication I think they can avoid some of the problems.

Q. Do you find with children that are on drugs there is often a drug- or alcohol--abuse problem with the parents?